Provider Demographics
NPI:1932699766
Name:MORTON, JILL (RN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:MORTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336A BISHOPS LODGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0261
Mailing Address - Country:US
Mailing Address - Phone:808-280-2658
Mailing Address - Fax:
Practice Address - Street 1:1574 STATE ROAD 502
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2697
Practice Address - Country:US
Practice Address - Phone:505-455-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-80573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse